BONE MARROW OEDEMA OF THE TALUS: TREATMENT WITH THE PROSTACYCLIN ANALOGUE ILOPROST

Aigner N., Petje G. , Schneider W. , Aigner G. , Meizer R., Landsiedl F.

Bone marrow oedema syndrome (BMOS) of the talus is a rare cause of pain in the foot with restricted treatment options.

We reviewed 10 patients with unilateral bone marrow oedema syndrome treated with the vasoactive prostacyclin analogue iloprost. This substance has a potency to dilate arterioles and venules and to reduce capillary permeability. All these rheological factors of the terminal vascular bed are discussed to be of pathogenetic importance for BMOS. Our therapy consisted of a series of five infusions with 20 mcrg of iloprost given over 6 hours on 5 consecutive days each. During and after treatment full weight bearing was allowed as tolerated. Mazur's foot score was used to assess function before, 1, 3 and 6 months after therapy.

During this time, the score improved from a mean of 57 (range 26 - 69) to 93,5 points (85 - 100). Plain radiographs were graded according to Mont with grade I lesions before and after therapy, indicating that no subchondral fracture or collapse occurred. Magnetic resonance imaging showed complete recovery of the bone marrow oedema from ARCO stage I to ARCO stage 0 within 3 months.

We believe that the parenteral application of the vasoactive drug iloprost might be a viable method in the treatment of bone marrow oedema syndrome.